What's Next For The Affordable Care Act? Your Questions Answered

The one thing that's certain is that there will be changes in the Affordable Care Act.

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Originally published on February 23, 2017 12:28 pm

No matter where you stand on the political spectrum, health care under the Affordable Care Act is going to change in the next few years. The Republican-led Congress has vowed to "repeal and replace" the health law known as Obamacare.

That has left many people anxious and confused about what will happen and when. So NPR's Morning Edition asked listeners to post questions on Twitter and Facebook, and we will be answering some of them here and on the radio in the weeks ahead.

Many of the questions so far have to do with timing.

For example, Steva Stowell-Hardcastle of Lewisburg, Penn., says: "I'm confused about what parts of the ACA have been repealed and when those changes take place."

First, despite social media headlines, nothing substantive has been changed in 2017. That's because making these changes is harder than it looks.

In January, Republicans in Congress passed a budget resolution that called for major changes to the law to be made in a subsequent bill.

Even though that process would allow them to pass a bill without Democratic votes, they haven't been able to agree on what those reforms should look like.

And there are several other obstacles.

First of all, they won't be able to repeal everything in one go, which counters a lot of the rhetoric coming out of the election. And they would be limited in what parts of the law they can replace.

That said, the Trump Administration has taken some action, but no concrete changes – yet. In January, Trump signed an executive order calling for federal agencies to "waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the act" that would "impose a fiscal burden" on states, individuals, healthcare providers, and others in the health industry.

While that could be widely interpreted, so far the only federal action in response to that order has come from the IRS. The IRS says it will not strictly enforce the "individual mandate" that requires most Americans to have health insurance. The agency noted, however, the requirement is still law.

A related question comes from Kathryn Henry of Iowa City, Iowa. She asks "if it is repealed, what happens to people like me who currently have insurance through it and when?"

Both President Trump and GOP congressional leaders have insisted that they want a smooth transition from the current system to a new one, particularly for the 11 million or so people who purchased coverage on the federal or state health insurance exchanges since the law took effect.

"We don't want to pull the rug out from under people while we're replacing this law," said House Speaker Paul Ryan, R-Wisc., in January. Trump has insisted that repealing the law and replacing it be done "essentially simultaneously," so as not to leave people without insurance.

Unless something unexpected happens, people who purchased insurance for 2017 should be covered through the remainder of the year.

The bigger question is what happens in 2018. The uncertainty alone is prompting some insurers to pull out of the individual insurance market — the market in which people don't get insurance through their employer. The individual market is the most affected by the health law.

For example, the insurance company Humana has already said it won't participate in the health insurance exchanges next year, and the CEO of Aetna told reporters that his company might drop out, too. If Congress deadlocks over how to overhaul the health law, more insurance companies could follow suit.

Insurers were supposed to tell the federal government if they planned to participate in the insurance exchanges by May 3, but the Trump Administration has now given them until the end of June.

Got more questions about what's happening to the ACA? I'll be back next week with answers. Just tweet @MorningEdition using the hashtag #ACAchat.

The Republican Congress is working to repeal and replace the Affordable Care Act also known as Obamacare. Many of us are confused about what's exactly going on. We asked you to post your questions on Twitter and Facebook, and this morning, we're going to answer a couple of them. We've got Julie Rovner of our partner, Kaiser Health News, in the studio to help us out. Hi, Julie.

JULIE ROVNER, BYLINE: Hi, Rachel.

MARTIN: All right, let's start with a question many listeners posed about the Affordable Care Act. This is listener Steva Stowell-Hardcastle from Lewisburg, Pa.

(SOUNDBITE OF ARCHIVED RECORDING)

STEVA STOWELL-HARDCASTLE: I'm confused about what parts of the ACA have been repealed and when those changes take place.

MARTIN: All right. So, Julie, has anything changed yet?

ROVNER: Not in 2017. There have been some small changes that were made to the law over the previous seven years but nothing big...

MARTIN: The big repeal hasn't happened.

ROVNER: The big repeal has not happened yet, despite what your social media might say or what some headlines have intimated. What has happened is that the Republican Congress has taken the first step to enable a repeal of part of the law. So they passed a budget resolution that said that there will be legislation down the line. We haven't seen that legislation yet. And also, Congress can't repeal the entire law because of the way the budget rules work. So whatever they're going to do, they can't make the entire thing go away unless they had 60 votes in the Senate, which they don't have.

MARTIN: All right. So let's get to our next question, which is really the big one - several listeners posed this. Listener Kathryn Henry from Iowa City, Iowa, has this question.

(SOUNDBITE OF ARCHIVED RECORDING)

KATHRYN HENRY: If the ACA is repealed, what will happen to people like me who have purchased health insurance for 2017 through healthcare.gov and when?

MARTIN: Kathryn has Obamacare, and she's not sure what's going to happen - a lot of people in this situation.

ROVNER: That's right, and no one is really sure what's going to happen. But people who purchased coverage for this year, for 2017, are probably fine. Republicans say that they want to have what they call a smooth transition so that people will not have, you know, what Speaker Paul Ryan called, you know, have the rug pulled out from under them.

MARTIN: Even Donald Trump has said he doesn't want there to be a gap in care.

ROVNER: That's correct. The problem with that is that insurers are already reacting to we don't know what the rules are going to be for 2018, and they're already announcing that they're not going to offer coverage in 2018 in the individual market. We're only talking about 5 percent of the population here. But they're talking about dropping out because they don't know what the rules are going to be and because they have to tell the government whether they're going to participate in May. So Congress really only has until May or - unless they want to extend that deadline. That's the confusion. So the uncertainty means that we don't know really what it's going to look like in 2018. Unless something dramatic happens, people should be OK for 2017.

MARTIN: So people like Kathryn literally have to just wait and see. They can't do any planning for years ahead.

ROVNER: No, that's right, and the insurers can't do any planning for years ahead, which is one of the insurers' issues. They want Congress to act fast so they at least know what the rules are going to be for next year. And no one knows yet.

MARTIN: Julie Rovner of our partner Kaiser Health News, she will be back next week to answer more of your questions about the ACA. You can tweet those questions - @MorningEdition. Use the hashtag #ACAchat. Hey, Julie, thank you so much.

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Treating people for free or for very little money has been the role of community health centers across the U.S. for decades. In 2015, 1 in 12 Americans sought care at one of these clinics; nearly 6 in 10 were women, and hundreds of thousands were veterans.

Some Republicans looking to scrap the Affordable Care Act say monthly health insurance premiums need to be lower for the individuals who have to buy insurance on their own. One way to do that, GOP leaders say, would be to return to the use of what are called high-risk insurance pools.

House Republicans are debating a plan to replace the Affordable Care Act that would give consumers tax credits to buy insurance, cut back on Medicaid and allow people to save their own money to pay for health care costs.

The outline plan is likely to take away some of the financial help low-income families get through Obamacare subsidies, and also result in fewer people being covered under the Medicaid health care program for the poor.